Melanie Cole, MS (Host): During routine or well-child visits, your child's healthcare provider will check their growth and development in order to find or prevent problems. Well-child visits also provide an opportunity for parents or guardians to ask questions and share concerns with their pediatrician.

Dr. Edward Levy, Pediatrician at MIT Health is here to tell us about scheduling routine visits for your child, how to prepare for those appointments, and what to do if you have questions between visits.

Welcome to Conversations with MIT Health. I'm Melanie Cole. Dr. Levy, I'm so glad to have you join us again today. As a parent myself, but of course, mine are like 20 and 23, but I do remember those first visits. So when does a new parent schedule that baby's first visit to their pediatrician?

Edward Raphael Levy, MD, MPH: Well, thanks for having me Melanie. And thanks for having survived your own parenthood. Although as I have older kids too, there's always new things that come up. The general approach is there are in the early times right after a baby's born, it's a really exciting time. There are a couple of things we want to support early.

One is nursing and getting that on track, and that is often aided by an early visit because oftentimes a mother's milk does not come in till day four. So even with lactation consultants in the hospital, it's a little bit like practicing without really having the milk. So we really want to support nursing and make an early visit for that. The other thing is hospitals are often asking us to evaluate babies for jaundice. Jaundice is a really common, virtually normal finding in a newborn, but if the levels of this jaundice get too high, it can cause problems down the line and it's very treatable. So oftentimes there's an early visit, a matter of days after leaving from the hospital to help with establishing nursing and to help with evaluating for jaundice. So it's often in the week there's a visit soon after hospital discharge, and in many places, the hospitals will not let you go home until you book that first appointment.

Melanie Cole, MS: It's a lot to think about Dr. Levy. I remember those days and it's exciting and it's a bit scary and it's a little bit exhausting as well. So while parents are thinking about that first visit, what do you want them to bring with them? Should they be bringing things to their new pediatrician? Family history, events during pregnancy, information?

Edward Raphael Levy, MD, MPH: Well, we're going to capture all that, and right now it's on paper forms, a lot of it; in terms of what the family's experience has been of this pregnancy, what the background of family history is, background of other children. So we do want to establish, in a fairly efficient way, where this new family is starting from, what's their base in terms of, is this a first child? What's their experience of healthcare with their other children? How was the pregnancy and delivery and the hospital care? But usually we capture this in terms of paper forms.

Melanie Cole, MS: And what questions would you like them to ask you, Dr. Levy? Because as new parents, you kind of don't know what things you're supposed to be thinking about. And you've mentioned nursing, and you mentioned jaundice. What other questions do you want parents to ask you when they come in, or what are some of the most frequently asked questions you get from new parents in those first few well visits?

Edward Raphael Levy, MD, MPH: So if we're talking early, there are just a few basic things because what a newborn is doing is switching from complete dependence on the mother's womb and placenta, the umbilical cord to sustaining life by absorbing nutrients, by feeding, by breathing, by maintaining body temperature, by establishing sleep wake cycles.

So in some ways going to be clear to most parents that, how's the baby feeding? What does sleep look like? What does awakeness look like? Very commonly there are newborn rashes, but I find that most parents intrinsically know where their questions are. It's kind of a very natural event.

So I don't think a lot of preparation has to go in because almost all the parents come to me wanting to know how the baby's weight is, how they're feeding. The thing I would tell them is, that there are no bad questions, particularly with the first baby. There are no inappropriate questions. There are no questions that kind of reveal, that you don't really know what you're doing because, we don't know who this little person is yet. They're declaring themselves. And we just ask parents to tune in and be honest and not to be concerned that there's anything that we don't want to do to support them.

Melanie Cole, MS: And what about immunizations, Dr. Levy? Because I am sure that especially in this day and age, some parents have questions about vaccinations, of which there are quite a few in that first year. So tell us a little bit about vaccinations. What do you tell parents about them, and if parents have questions about them, what do you tell them in that case?

Edward Raphael Levy, MD, MPH: Well, it has really, evolved, and even evolved dramatically, in the last few years with the COVID vaccinations. So where we are at MIT Health, the biggest issues tend to be that to some extent vaccination schedules are uniform, and that certain diseases, and approaches to them are global.

But there is a set of diseases which different countries based on what diseases are common, philosophies of healthcare, where there are different vaccine schedules. So because MIT is a very international population, we're often looking at the difference between the schedule as it is in the US and recommended and what is from the home country.

So, that's often something we're weighing with families and then obviously we're weighing the COVID vaccination now. I think one thing that the parents of infants need to be aware of that comes up that you don't find a lot of discussion of, is giving COVID vaccines with the other vaccines because infants become eligible for COVID vaccination at six months of age where there are additional vaccines.

So oftentimes, our discussion with parents is about the timing and timing of vaccines, rather than is this vaccine recommended, not recommended? Do we give it or not give it? Very often there are, timing issues. So in general our approach at MIT is because we have international population to support people in the schedules of their home countries when that's a safe and reasonable thing to do. But when we really think, that based on what the epidemiology is here, that that would be not the best for the baby. We will, you know, really further that discussion.

Melanie Cole, MS: That's so interesting Dr. Levy and thank you for explaining that. What do parents do if they have questions in between visits? Back in my day, boy, we'd call our pediatrician at two in the morning hysterical parents, you know how we are, but nowadays there's tele visits and there's phone visits. There's all kinds of ways to reach our pediatrician when we're going off the rails a little bit. So tell us how we reach you. What, what do you want parents to know about that?

Edward Raphael Levy, MD, MPH: So that's a great question and it always depends on the level of concern. So, it never hurts to call, particularly about something urgent. There are basically three pathways, right? There's calling, there's sending through, what's called a patient portal, , they're sending a direct message, to the provider about a concern. And then there's establishing a tele visit wher you know, you want to have a fuller discussion. You don't necessarily feel like you need to bring the child in, but there's something been going on at school or behavior you've been observing, and you want to have a fuller discussion.

A tele vist can be a great way to accomplish that. So those are really the three different ways. I think if it's really, you're concerned about something happening in a short timeframe, like you don't have time, then a phone call's already best in having a closed loop. Because messages, although we try and be on top of our messages, like during a busy day, unless a message is flagged, it may not get attention.

And sometimes we want to know about things sooner than later. Let me give you an example where it's really important to know about something sooner, which is, let's say, a toddler has like a high fever, like a 104. We don't want to know about that at 4:30 towards the end of the day, because the way MIT Health is set up, we don't have any laboratory services.

We can't really help understand and then we're going to have to for evaluation, send the folks to, uh, ER or urgent care, which we'd rather take care of our own patients. If we find about earlier in the day, at 1230 there's a fever and we get a call at one, we're going to try and see the family as soon as possible.

So if we need to collect urine or do a throat swab or evaluate it, we can take care of that for the family in a place they know, with people they know. So that's a great example of when you don't want to wait. A behavioral concern that is a child like is refusing to go to school, that's something where having a conversation or setting up a tele visit is a great way to move that kind of problem forward.

Melanie Cole, MS: Well, there are so many and we could really talk for a long time. And before we wrap up, Dr. Levy, while there's cord care and diapering and crying and bathing and breastfeeding and first foods, and I mean you and I, and of course sleeping, which is a huge one. We could really do 10 of these and cover all of those things.

But because these are a little bit shorter, I'd like you to tell parents some of the most important information that you share with them. And while you're telling them your best advice, I'd like you to speak about the aspects of selfcare for the parents. Because sometimes in those first few weeks, especially first few months, it's exhausting and we may not be getting the support we need.

There may be symptoms of postpartum depression, there may be all of these things going on. I'd like you to speak to the parents just now and let them know what you would like them to know about that first year of baby's life, how exciting and how tiring, but how really wonderful it can be and how our pediatricians are there to help us through it all.

Edward Raphael Levy, MD, MPH: The most important information is to be aware of the gap between the expectation of parenting young children and the reality. Oftentimes there's an expectation of instant rapport and bonding and attachment that does happen at times, that is very present; it doesn't happen for everybody with every baby. And there's a gap between the imagined and kind of the lived experience you're referring to, particularly in the early days of a baby who may not sleep, who may fuss, who may spit up, who can seem hard to comfort and you don't know why, which is what we call colic.

So oftentimes there's a really big gap between what people expect parenting to be and the intensity of the job. It's oftentimes the hardest job people have. And being at MIT, many times parents will tell me that it's easier for them to do this world class, cutting edge research, than their parenting. And so it's really challenging. But the gap doesn't have to stay, and so what do you fill in that gap between the lived experience of parenting and what you hoped it would be, and it's there because we can help anybody make it out. And people, almost universally get through it.

And it's a mix of resources to deal with this intense stress. And it's more stressful for some people than others. Oftentimes naturalistic supports and what I mean by that is, family, friends, community, are critical and it's really challenging at MIT where people have migrated, often left continents, left families and friends of origin pursuing the MIT opportunities.

But if sometimes neighbors, there are resources available through MIT, human resources for assistance with babies, we both can point towards other resources and also help with issues like sleep and feeding, and soothing and comforting and help point towards all the other resources out there.

The most important information is it's a hard job. It doesn't come naturally. There is a lot of help. There are a lot of resources to support becoming a new parent, and we are both a resource and also a signpost to guide you to other resources. In Cambridge at the Riverside Early Intervention, for example, there's a program just for supporting new families that really kind of does some wraparound services. Sometimes you're looking at kind of a steep hill. But we can help you find the steps up the hill.

Melanie Cole, MS: Well, you certainly can. Thank you so much, Dr. Levy for joining us. What an exciting time for new parents. Thank you for telling us about what expect at those well visits.

Listeners can visit Health.mit.edu for more information and to get connected to one of our providers. That concludes this episode of Conversations with MIT Health. Please remember to subscribe, rate and review this podcast and all the other MIT Health podcasts. . I'm Melanie Cole. Thanks so much for joining us today. 

That concludes this episode of Conversations with MIT Health. Please always remember to subscribe, rate, and review this podcast and all the other MIT Health podcasts. I'm Melanie Cole.